Active Treatment Improves Overall Survival in Extremely Older Non-Small Cell Lung Cancer Patients: A Multicenter Retrospective Cohort Study

Characteristics and clinical outcomes of patients with nonsmoking small cell lung cancer in Korea

BACKGROUND

The aim of this study was to investigate the characteristics and clinical outcomes of patients with nonsmoking small cell lung cancer (SCLC) using a nationwide registry in Korea.

METHODS

The Korean Association for Lung Cancer developed a registry in cooperation with the Korean Central Cancer Registry (KCCR) and surveyed approximately 10% of recorded lung cancer cases.

RESULTS

From 2014 to 2016, the KCCR registered 1,043 patients newly diagnosed with SCLC among a total of 8,110 lung cancer patients. In subgroup analysis, Kaplan meier survival analysis showed that the overall survival (OS) was significantly shorter in the nonsmoking subgroup than the ever-smoking subgroup of SCLC patients with extensive disease (6.99 vs. 9.68 months; P = 0.016). Among SCLC patients with limited disease, OS was also shorter in the nonsmoking subgroup, without statistical significance (19.4 vs. 23.5 months; P = 0.247). In a multivariate analysis using a Cox regression model, never smoking was not associated with shorter OS, but older age, extensive stage, poor performance status (Eastern Cooperative Oncology Group grade ≥ 2), male sex, no prophylactic cranial irradiation, and no active treatment (chemotherapy and/or radiotherapy) were associated with poor prognosis.

CONCLUSION

This evaluation of an unbiased nationwide survey dataset revealed that a significant proportion of Korean SCLC patients were never-smokers. No history of smoking appeared to be a significant prognostic factor according to the univariate analysis but was confirmed to be statistically insignificant through a multivariate analysis of the total population. Reasons for a poor prognosis may include the possibility that a high rate of the elderly population is composed of nonsmokers who did not receive active treatment.

Association between clinical outcomes and local treatment in stage IV non-small cell lung cancer patients with single extrathoracic metastasis

Background

Local treatment (LT) such as radiotherapy and metastasectomy on metastatic sites may improve outcomes in oligometastatic NSCLC patients, but more data are necessary to support LT in oligometastatic diseases. Patients with single extrathoracic metastatic lesion are more likely to benefit from local therapy. In this study, we evaluated the impact of LT in NSCLC patients with a single extrathoracic metastatic lesion.

Methods

Data were obtained from the Korean Association for Lung Cancer Registry (KALC‐R), a database created using a retrospective sampling survey by the Korean Central Cancer Registry (KCCR) and the Lung Cancer Registration Committee.

Results

A total of 787 NSCLC patients with a single extrathoracic metastatic lesion were evaluated. In the multivariate analysis for OS, age, female sex, poor performance score, squamous histological subtype, LT, and initial treatment modality showed significant associations. Regarding LT, groups that underwent curative LT were significantly associated with better OS compared to groups that did not undergo LT (p = 0.011, HR 0.448, 95% CI: 0.242–0.829). In the multivariate analysis of patients who underwent LT, poor performance score, initial treatment modality, and T stage were independently associated with poor OS. Compared to the T1 stage, T3 stage showed an HR of 2.470 (95% CI: 1.309–4.663; p = 0.005) and T4 stage showed an HR of 2.063 (95% CI: 1.093–3.904; p = 0.026).

Conclusion

In NSCLC with a single extrathoracic metastatic lesion, LT, especially for curative purposes, has an independent association with OS. Moreover, among the patients who received LT, factors such as T stage, poor performance score, and initial treatment modality were significantly associated with OS.